National efforts are focused on improving medical quality and reducing medical costs by implementing standardized electronic medical record keeping which enables secure exchange of health information between different systems. However, rural health care providers and those who have small offices may not have the financial resources or expertise to purchase and maintain necessary expensive hardware and software applications which are necessary to join in this move toward electronic medical records (EMRs). EMRs are the most basic requirement for information sharing. Additionally, EMR applications have two critical concerns: a) security: the system must impeccably protect the privacy of the health records of the American people;and b) affordability: the system must be affordable both at acquisition time and during operation and maintenance. Therefore, the advancement of current software and computer engineering techniques is required for the development and evaluation of trustworthy, cost-effective, and standards-based EMR applications. We propose that the EMR application needs of rural and small-practice ambulatory health care providers be satisfied via open source EMR applications that are reliable, secure, privacy-preserving, standards/regulations-based, and able to be integrated with other health care systems. Both hardware and software installation, usage, and maintenance are securely optimized to improve affordability. The end product of our work is a set of servers on which open source EMR applications run that serve many medical practices simultaneously as they run their offices and securely store, utilize, and share patient data. Hardware cost is minimized because algorithms will be used to establish an optimized, secured sharing of these servers amongst the practices. Software cost is minimized due to the use of open source software. Software maintenance cost is reduced because software upgrades are all done in one location. If successful, our findings would suggest a model in which states or regions support the centralized servers and the IT professionals who administer and maintain the servers, likely with cost sharing by the medical practitioners.